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Paraspinal and spinal infections represent a second distinct cohort of infections in Michigan after meningitis in patients who received contaminated methylprednisolone acetate injections for pain syndromes. As of March 25, 2013, Michigan had reported 165 (54%) of the total 306 spinal or paraspinal infections nationally. This outbreak presents several challenges, including unknown incubation periods, a broad spectrum of clinical presentations, latent disease, and therapy that might be toxic in some patients. Early diagnosis and initiation of therapy might reduce the risks associated with contaminated MPA injections. Exposed patients should be followed up due to the lengthy incubation periods; however, the decision to initiate therapy should be balanced by the risks of toxicity. Patients who received contaminated methylprednisolone acetate injections, compounded by the New England Compounding Center after May 21, 2012, might still be at risk of developing spinal and paraspinal infections.

2. Assessment of Risk for Exposure to Bats in Sleeping Quarters Before and During Remediation — Kentucky, 2012

CDC
Division of News & Electronic Media 404-639-3286

Bats are a natural reservoir for rabies transmission, and rabid bats have been found in all 48 contiguous states. Each year, CDC and state health departments receive reports about mass human exposure to bats in summer camps, volunteer trips, or other settings of human congregation in areas with large bat populations. There are currently no recommendations that address how a contact investigation and risk assessment should be performed when an incident of mass human exposure to bats occurs. This report describes an effective method for performing contact investigations after a mass human exposure to bats. If mass human bat contact occurs in the absence of animal testing, the contact investigation and risk assessment described in this report can be used to manage the potential risk of rabies transmission.

3. Microbiologic Contamination of Filter Concentrates from Public Pools as Evidence of the Need for Improved Swimmer Hygiene — Atlanta, Georgia, 2012

CDC
Division of News & Electronic Media 404-639-3286

A study of public pools found that feces are frequently introduced into pool water by swimmers. Water samples from pool filters were tested for Escherichia coli, a fecal indicator, which was detected in 93 (58 percent) of 161 samples. The tests cannot determine whether the E. coli represents risk to swimmers, but they do indicate that swimmers frequently introduced fecal material into pool water, which could lead to spreading germs to other swimmers. Swimmers can minimize fecal contamination and help keep germs out water by taking a pre-swim shower and not swimming when ill with diarrhea. Aquatics staff can kill germs in pools by maintaining disinfectant level and pH according to state and local public health standards, which are enforced by environmental health specialists (pool inspectors).